Ventilatory support in the acute respiratory distress syndrome

Ventilatory support in the acute respiratory distress syndrome (ARDS) has u ndergone considerable transformation in the 1990s. Current approaches inclu de lung protective techniques which, while attempting to recruit and mainta in lung volume, limit the shear stresses associated with ventilation by avo iding both alveolar overdistension and cyclical end-expiratory collapse. In addition, gas exchange targets have been liberalised and ventilatory condu ct is much more tailored to individual pulmonary mechanics. Assessment of t he inspiratory volume-pressure (V-P) curve provides information which can d irect ventilator settings. Recent information from clinical trials has prov ided new insights into appropriate ventilatory modification and set the fou ndation for future clinical investigations.